Assessing the work relatedness of diagnoses in occupational health primary care appointments: a 3-year review of electronic medical records

Abstract

Objectives: This is the first study to use real-life electronic medical record data from occupational health (OH) primary care to evaluate how often physicians assess and confirm diagnoses' work relatedness (the definition implying causal or aggravating factors at work) in relation to the physicians' expertise, allocated appointment time and type of diagnosis.

Methods: We analysed registered data on face-to-face appointments with an occupational physician (n=70 163) at a Finnish OH service provider in 2020-2022, using cross tabulations and logistic regression to estimate the likelihood of assessments and conclusions that the diagnoses are work related, depending on whether the physician was specialised in OH, the appointment duration and the diagnoses' International Classification of Diseases-10 (ICD-10) categories.

Results: The work relatedness of diagnoses was assessed in 58.1% of appointments, most likely when appointments were longer and diagnoses belonged to the ICD-10 categories of injuries, mental disorders and rarely used 'other reasons for visiting healthcare' category. The main diagnosis was considered work related in 8.9% of the appointments, more likely when the physician was an OH specialist and the appointments were longer. In the adjusted models, the highest ORs (OR, 95% CI) for the diagnoses being classed as work related were in cases of mental disorders (5.82, 5.01 to 6.76), musculoskeletal diseases (7.46, 6.66 to 8.35) and injuries (18.14, 16.06 to 20.48).

Conclusion: Although a requirement, work relatedness was assessed in less than 60% of the appointments in OH primary care. Work-related diseases were rarely confirmed. Further research is required to find factors that could improve such assessments.

Keywords: Occupational Health; Occupational Health Services; Physicians.

Figure 1. Definition of work relatedness in EMR covers the bolded boxes. EMR, electronic medical record.